Lake Health West Med Center in Willoughby streamlines system to help ER patients

CLEVELAND, Ohio -- Patients heading into the emergency department at Lake Health West Medical Center in Willoughby are greeted at the door by a registered nurse before they even have a chance to get to the reception desk.

The nurse ushers the patient into a private evaluation room, assesses his or her condition and takes down a health history. Those with acute symptoms, such as chest pain, are treated immediately, while less-severe cases are prioritized by the nurse.

The change is one of many that the Lake County nonprofit hospital system has embraced to streamline and improve services. Health care reform is driving such changes nationwide, says Cynthia Moore-Hardy, president and CEO of Lake Health.

Ideas for the new procedures in the emergency room and other areas of the health system are coming directly from employees who care for patients, through a process known as Lean, Moore-Hardy explains.

The administrative team decided to embark on the Lean system, first looked at by Toyota in the 1930s, which focuses on cutting out waste while increasing efficiency using the firsthand knowledge of people on the job.

To develop new procedures, ER employees met in groups of 10 for all-day, weeklong sessions in which they talked about the pros and cons of practices in place. The groups included technicians, nurses, secretaries and physicians. Everyone had equal opportunity for input.

"They literally mapped out every step of the process from the patient's perspective, including all the things that go on behind the scenes," Moore-Hardy says. Proposed changes were tried rapidly, and those that worked to groups' satisfaction were adopted.

The process took about 10 months from group meetings to implementing changes, says Gary Robinson, Lake Health's vice president of government and community affairs.

The teams found thatnurses directly approaching patients in the emergency department reduced time in the waiting room, he says.

The teams also discovered significant delays if a patient needed to be admitted, he says. "They determined that it could take from one to six hours to get the person from the emergency room to an inpatient bed. That was unacceptable."

Reasons for delays ranged from time spent waiting for transport to a room to delays cleaning and preparing rooms. Electronic messages and faxes between departments also slowed the process.

Lean teams empowered the nurse caring for the ER patient. Now, that ER nurse has responsibility for calling the floor nurse so see if a bed is ready, calling maintenance if the room isn't ready and taking the patient up to the floor. This also allows the ER nurse to exchange information with the floor nurse in front of the patient so that he or she has a better idea of what's going on and can ask questions.

"It's quicker, more efficient and better for the patient, who can participate in the discussion," Robinson says

The new procedure has cut the average time of getting an ER patient admitted and into a room to under one hour.

Discharge time was reduced as well. Doctors and other caregivers on morning rounds see patients set to be discharged that day first. This gets patients home earlier and frees up beds sooner.

Robinson says the staff is evaluating and tweaking processes and tasks constantly to make sure everything is working to expectations. The approach is working so well, he says, that the health system is using the Lean system to streamline procedures in other areas.

In the coming months, Lake Health employees will take a look at other facilities within its hospital system, including the perioperative department at West Medical Center, Lake Health Physician Group and two other departments.

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